Table 1.
Demographic and Clinical Characteristics of 11700 Patients With First-Time Bacteremia Identified at the Emergency Department in the Derivation Population
| Characteristics | Available No. | Patients With Bacteremiaa | 7-Day Mortality | ||
|---|---|---|---|---|---|
| Survivors | Nonsurvivors | ||||
| n = 11700 | n = 10702 (91.5%) | n = 998 (8.53%) | P Value | ||
| Age, median (Q1, Q3), y | 65.5 (52.6, 77.0) | 65.1 (52.4, 76.8) | 68.0 (54.6, 79.1) | <.0001 | |
| Male | 11 700 | 5681 (48.6) | 5066 (47.3) | 615 (61.6) | <.0001 |
| Comorbidityb | |||||
| Hypertension | 11 700 | 2819 (24.1) | 2569 (24.0) | 250 (25.1) | .46 |
| Congestive heart failure | 11 700 | 798 (6.82) | 723 (6.76) | 75 (7.52) | .36 |
| Coronary artery disease | 11 700 | 979 (8.37) | 906 (8.47) | 73 (7.31) | .21 |
| Chronic lung disease | 11 700 | 921 (7.87) | 811 (7.58) | 110 (11.0) | .0001 |
| Diabetes mellitus | 11 700 | 2015 (17.2) | 1838 (17.2) | 177 (17.7) | .65 |
| Liver cirrhosis | 11 700 | 723 (6.18) | 619 (5.78) | 104 (10.4) | <.0001 |
| Renal insufficiency (eGFR <60mL/min/1.73 m2) | 11 693 | 6506 (55.6) | 5658 (52.9) | 848 (85.0) | <.0001 |
| Rheumatic disease | 11 700 | 158 (1.35) | 141 (1.32) | 17 (1.70) | .31 |
| Transplantation | 11 700 | 74 (0.63) | 72 (0.67) | 2 (0.20) | .07 |
| Cancer | 11 700 | 2187 (18.7) | 1834 (17.1) | 353 (35.4) | <.0001 |
| AIDS/HIV | 11 700 | 45 (0.38) | 40 (0.37) | 5 (0.50) | .53 |
| Medication use within 14 d before index ED admission | |||||
| Recent systemic antibiotic use | 11 700 | 1005 (8.59) | 909 (8.49) | 96 (9.62) | .22 |
| Recent steroid use | 11 700 | 1200 (10.3) | 974 (9.10) | 226 (22.7) | <.0001 |
| Recent NSAID | 11 700 | 823 (7.03) | 732 (6.84) | 91 (9.12) | .007 |
| Medical history before index ED admission | |||||
| Dialysis within 30 d prior | 11 700 | 289 (2.47) | 267 (2.49) | 22 (2.20) | .57 |
| Hospitalization within 90 d prior | 11 700 | 2700 (23.1) | 2354 (22.0) | 346 (34.7) | <.0001 |
| Implants in placed within 90 d prior | 11 700 | 481 (4.11) | 448 (4.19) | 33 (3.31) | .18 |
| Central venous catheter in placed within 14 d prior | 11 700 | 27 (0.23) | 22 (0.21) | 5 (0.5) | .06 |
| Physiological measurement within 48h after the index ED admission (first) | |||||
| Systolic blood pressure, mmHg | 11 146 | 127 (108, 149) | 128 (110, 150) | 108 (88, 131) | <.0001 |
| Heart rate, /min | 11 179 | 108 (92, 122) | 107 (92, 121) | 112 (92, 132) | <.0001 |
| Respiratory rate, /min | 9150 | 20 (20, 22) | 20 (20, 22) | 22 (20, 26) | <.0001 |
| Ear temperature, °C | 11 343 | 38.2 (37.1, 39.1) | 38.2 (37.2, 39.1) | 36.9 (36, 38.1) | <.0001 |
| qSOFA, median (Q1, Q3) | 8926 | 1 (0, 1) | 0 (0, 1) | 1.5 (1, 2) | <.0001 |
| 0 | 4266 (47.8) | 4186 (50.7) | 80 (11.8) | ||
| 1 | 3137 (35.1) | 2879 (34.9) | 258 (38.2) | ||
| 2 | 1267 (14.2) | 1018 (12.3) | 249 (36.8) | ||
| 3 | 256 (2.87) | 167 (2.02) | 89 (13.2) | ||
| Components of Pitt Bacteremia Scorec | |||||
| Ear temperature | 11 343 | .70 | |||
| 36.1°C–38.9°C | 7247 (61.9) | 6692 (64.0) | 555 (62.6) | ||
| 35.1°C–36.0°C or 39.0°C–39.9°C | 2985 (25.5) | 2743 (26.2) | 242 (27.3) | ||
| ≤35°C or ≥ 40°C | 1111 (9.50) | 1021 (9.76) | 90 (10.2) | ||
| Hypotension | 11 700 | 3429 (29.3) | 2663 (24.9) | 766 (76.8) | <.0001 |
| Mechanical ventilation | 11 700 | 1865 (15.9) | 1308 (12.2) | 557 (55.8) | <.0001 |
| Cardiac arrest | 11 700 | 569 (4.86) | 233 (2.18) | 336 (33.7) | <.0001 |
| Mental status | 11 688 | <.0001 | |||
| Alert (GCS 15) | 9137 (78.1) | 8693 (81.3) | 444 (44.6) | ||
| Disoriented (GCS 9–14) | 1554 (13.3) | 1302 (12.2) | 252 (25.3) | ||
| Stuporous (GCS 4–8) | 657 (5.62) | 520 (4.86) | 137 (13.8) | ||
| Comatose (GCS 3) | 340 (2.91) | 178 (1.66) | 162 (16.3) | ||
| Pitt Bacteremia Score | 11 343 | 1 (0, 2) | 1 (0, 2) | 5 (2, 8) | <.0001 |
| Bloodstream Infection Mortality Risk Score | 11 343 | 4 (2, 7) | 4 (2, 6) | 9 (7, 9) | <.0001 |
| Biochemical profiles within 48h after the index ED admission (first) | |||||
| hs-CRP, mg/dL | 11 522 | 11.0 (3.35, 21.1) | 10.3 (3.02, 20.2) | 18.3 (8.51, 28.0) | <.0001 |
| White blood cell count, ×103/μL | 11 687 | 11.9 (7.89, 16.7) | 11.9 (8.10, 16.5) | 10.6 (3.97, 18.5) | <.0001 |
| Neutrophil-to-lymphocyte ratio | 11 611 | 13.2 (7.37, 22.8) | 13.3 (7.56, 22.7) | 11.9 (4.83, 24.1) | <.0001 |
| Neutrophil band | 410 | 7.0 (3.0, 16.0) | 6.0 (2.5, 15.0) | 8.0 (3.0, 18.0) | .14 |
| Platelet, ×103/μL | 11597 | 171 (115, 234) | 174 (121, 236) | 113 (47.7, 211) | <.0001 |
| Red blood cell, ×106/μL | 9732 | 4.02 (3.40, 4.52) | 4.06 (3.47, 4.55) | 3.44 (2.85, 4.00) | <.0001 |
| Blood urine nitrogen, mg/dL | 10 947 | 20 (13, 37) | 19 (13, 33) | 45 (27, 72) | <.0001 |
| Serum creatine, mg/dL | 11 651 | 1.20 (0.88, 2.00) | 1.16 (0.85, 1.84) | 2.10 (1.37, 3.55) | <.0001 |
| eGFR, mL/min/1.73 m2 | 11 651 | 54.1 (28.9, 82.4) | 56.9 (31.5, 84.0) | 28.1 (14.8, 47.0) | <.0001 |
| Serum sodium, mmol/L | 11 593 | 134 (131, 137) | 134 (131, 137) | 133 (128, 138) | .0008 |
| Serum potassium, mmol/L | 11 623 | 3.7 (3.4, 4.2) | 3.7 (3.3, 4.1) | 4.2 (3.6, 5.0) | <.0001 |
| AST, IU/L | 8703 | 40 (27, 79) | 38 (26, 72) | 66 (38, 158) | <.0001 |
| ALT, IU/L | 9367 | 30 (18, 57) | 29 (18, 56) | 38 (22, 73) | <.0001 |
| RDW, % | 9680 | 14.1 (13.2, 15.7) | 14.0 (13.1, 15.5) | 15.8 (14.3, 18.1) | <.0001 |
| Glucose, mg/dL | 11 603 | 145 (117, 212) | 145 (118, 210) | 143 (103, 228) | .0002 |
| Lactate, mg/dL | 4433 | 26.2 (16.1, 45.9) | 23.8 (14.9, 39.5) | 54.5 (28.5, 99.8) | <.0001 |
| Hemoglobin, g/dL | 11 641 | 11.9 (10.1, 13.4) | 12.1 (10.2, 13.5) | 10.4 (8.6, 12.2) | <.0001 |
| Infection sourced | 11 700 | <.0001 | |||
| Genitourinary | 4214 (36.0) | 4100 (38.3) | 114 (11.4) | ||
| Respiratory | 2108 (18.0) | 1727 (16.1) | 381 (38.2) | ||
| Digestive | 1891 (16.2) | 1796 (16.8) | 95 (9.52) | ||
| Skin and soft tissue | 838 (7.16) | 782 (7.31) | 56 (5.61) | ||
| Nervous system | 149 (1.27) | 137 (1.28) | 12 (1.20) | ||
| Musculoskeletal | 112 (0.96) | 109 (1.02) | 3 (0.30) | ||
| Circulatory | 126 (1.08) | 116 (1.08) | 10 (1.00) | ||
| Primary bacteremia | 2222 (19.0) | 1896 (17.7) | 326 (32.7) | ||
| Implant | 34 (0.29) | 33 (0.31) | 1 (0.10) | ||
| Unclassified | 6 (0.05) | 6 (0.06) | 0 (0) | ||
| Pathogens causing bacteremia | 11 700 | <.0001 | |||
| Gram-negative | 8589 (73.4) | 7903 (73.9) | 686 (68.7) | ||
| Gram-positive | 2849 (24.4) | 2587 (24.2) | 262 (26.3) | ||
| Both | 262 (2.24) | 212 (1.98) | 50 (5.01) | ||
| Resistant pathogens causing bacteremia | |||||
| Methicillin-resistant Staphylococcus aureus | 1470 | 574 (39.1) | 493 (37.9) | 81 (47.9) | .01 |
| Vancomycin-resistant Enterococcus | 354 | 34 (9.60) | 30 (9.49) | 4 (10.5) | .84 |
| Carbapenem-resistant Enterobacteriaceae | 7245 | 81 (1.12) | 76 (1.13) | 5 (0.96) | .71 |
| Ceftriaxone-resistant Enterobacteriaceae | 7245 | 809 (11.2) | 737 (11.0) | 72 (13.8) | .05 |
| Antibiotic treatment during episodee | 11 700 | ||||
| Inappropriate use | 4318 (36.9) | 3924 (36.67) | 394 (39.48) | .08 | |
| Time to antibiotic use, h | 9946 | 1.70 (1.12, 2.60) | 1.75 (1.17, 2.65) | 1.28 (0.80, 1.93) | <.0001 |
Abbreviations: AST, aspartate aminotransferase; ALT, alanine transaminase; ED, emergency department; eGFR, estimated glomerular filtration rate; GCS, Glasgow Coma Scale; hs-CRP, high-sensitive C-reactive protein; ICD, International Classification of Diseases; NSAID; nonsteroid anti-inflammatory drug; qSOFA, quick Sepsis-Related Organ Failure Assessment; RDW, red blood cell volume distribution width.
Values for the continuous variables are expressed as median (interquartile range), and values for the categorical variables are expressed as frequency (%).
Comorbidities were defined as having ICD diagnosis within 1 year before the index ED admission, if not otherwise defined. Rheumatic diseases, transplantation, and cancer were defined as having the catastrophic illness diagnosis any time before the index ED admission (Supplementary Table 3).
We obtained data for each component recorded within 48 hours after the ED admission and calculated the Pitt Bacteremia Score.
Infection source was defined as the ICD diagnosis during the index ED episode or the following hospital admission (Supplementary Table 4).
Inappropriate antibiotic was defined as when the susceptibility results did not prove that bacteria were susceptible to the given antibiotic (Supplementary Figure 1).